History

Patients may experience limb heaviness that is aggravated with dependency and relieved with elevation. One half of patients experience pain. The pain may be caused by tissue ischemia or by mass effect on local nerves. Some lesions, such as glomuvenous malformations, can be tender to palpation.
[11]

The increased blood flow to the limb in congenital arteriovenous malformation (AVM) or arteriovenous fistula (AVF) may result in increased growth of the limb (ie, one leg may be larger and longer than the other). In acquired AVFs, a history of trauma (eg, gunshot wound, stab wound, or even blunt trauma and fractures) can exist. AVF can also occur after medical diagnostic or interventional procedures (eg, angiography) or even after operative procedures that have caused inadvertent trauma to the artery and vein.

Next:

Physical Examination

Small AVFs and AVMs may be totally asymptomatic and may be discovered incidentally. Large AVFs may present with increased size of the limb, mild discoloration, swelling, or prominent veins with audible murmur or palpable thrill. (See the images below.)

The lesion may be pulsatile. The Branham sign may be present (slowing of the heart rate upon compression proximal to the AVM). Patients may develop hyperhidrosis, hypertrichosis, hyperthermia, or a palpable thrill or bruit over the lesion. They may have functional impairment of limbs or joints from mass effect or gangrene from prolonged tissue ischemia. Visceral AVMs can present with hematuria, hematemesis, hemoptysis, or melena.

Rarely, patients present initially with signs of congestive heart failure (eg, dyspnea, leg edema). This is particularly common when the communication is between a very large artery and a vein.

Previous

Next:

Complications

Except for very small AVFs, all acquired AVFs must be treated to prevent complications of distal limb ischemia, continued large flow of blood with eventual heart failure, and rarely infection (eg, endocarditis). Recurrence is a complication of inadequate or incomplete treatment.

Disclosure: Received salary from Medscape for employment. for: Medscape.

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California

Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California